Neoplasia I

Introduction

Husni Maqboul, M.D.

Terminology

• Tumor : Pathologic disturbance of growth,

characterized by excessive and unnecessary
proliferation of cells
• Galen (131 - 201 AD )
– Swelling according to nature ( pregnancy )
– Swelling exceeding nature ( Callus )
– Swelling contrary to nature
Terminology
• Hamartoma : Excessive but focal overgrowth
of cells and tissues native to the organ in
which it occurs. Cellular elements are mature,
but do not produce normal architecture
– Hamartroma of lung
– Angiomas
– Pigmented nevi
 Terminology

• Choristoma (Heterotopia) : Normal cells or tissues,

that are present in abnormal locations
– Pancreatic cells in the wall of stomach or
intestine
– Nests of adrenal cells in kidney , lung or ovaries
Terminology

• Neoplasms : Persistent , abnormal and

relatively autonomous proliferation of cells
occurring as a result of permanent cellular
defect that is passed to the progeny. Usually
develops due to a factor(s) , but once
developed , becomes independent of them.
Types of neoplasms
• Neoplasms
– Parenchyma made up of neoplastic cells
– Supporting host derived stroma
• Benign: localized and amenable to surgical
removal; patient usually survives
• Malignant: invasive tumor capable of
destroying structures and spread to distant
sites (metastasis); may result in early death
of the patient
Examples of benign tumors

• Epithelial
– Adenoma: benign glandular tumor
– Papilloma : benign surface epithelial tumors
– Polyp : benign tumor projecting over mucosal
surface
– Cystadenoma : benign epithelial tumor forming
hollow cystic mass
Examples of benign tumors
• Mesenchymal
– Chondroma: benign cartilaginous tumor
– Leiomyoma: benign smooth muscle tumor
– lipoma: benign tumor of fat
– Fibroma: benign tumor of fibrous tissue
• Mixed
– Benign Mixed Tumor –divergent differentiation of
stem cell (pleomorphic adenoma)
– Fibroadenoma – neoplastic fibrous component
• More than one germ cell layer
– Benign teratoma – mature components
leiomyomas
adenoma
Examples of malignant tumors

• Sarcoma (mesenchymal derivation: fibrosarcoma,

chondrosarcoma)
• Carcinoma (epithelial derivation: adenocarcinoma,
squamous cell carcinoma)
– Squamous
– Adeno
– Transitional
• Lymphoma/leukemia
adenocarcinoma
carcinoma
• The terms “benign” and “malignant”
describe the biologic behavior of a tumor
• The biologic behavior is characterized by
degree of differentiation of the tumor , rate
of growth (and rate of cell death) ,
infiltration of surrounding tissue, and
dissemination to distant sites
Differentiation

• Well-differentiated tumors contain cells that

resemble the normal cells of origin
• Poorly-differentiated or undifferentiated
tumors contain cells that do not resemble
their normal counterparts (ancillary studies
may be needed to determine the cell of
origin)
well-differentiated
poorly-differentiated
 Differentiation
• Benign tumors are composed of well-
differentiated cells.
• Malignant tumors are characterized by a
wide range of cellular differentiation.
• Anaplasia (cellular pleomorphism,
hyperchromatic nuclei, high N:C ratio, giant
cells, bizarre nuclei) is a feature of
malignant tumors.
anaplasia
Dysplasia
• denotes a loss of architectural organization
and a loss of cell uniformity in epithelium
• pleomorphism and mitoses are more
prominent than in the normal
• usually graded: mild, moderate, severe, and
carcinoma-in-situ
• mild to moderate dysplasia is potentially
reversible
normal epithelium
dysplasia
Dysplasia

• Dysplasia is a non-neoplastic proliferation.

• Dysplasia may or may not progress to
cancer.
Rate of growth

• In general, benign and well-differentiated

malignant tumors have a slower rate of
growth than moderately-differentiated and
poorly-differentiated malignant tumors.
• There are exceptions. Blood supply, site,
and hormonal stimulation are factors that
can affect the growth rate of tumors.
Invasion

• Benign tumors usually grow by slow

expansion.
• Malignant tumors usually infiltrate and may
destroy surrounding tissue (cell surface and
the extracellular matrix play an important
role).
Functional characteristics

• Benign tumors are more likely to function

• Epithelial tumors can produce mucin
• Hormonal production can be unregulated
• Inappropriate production of hormones by
different type of cells
• Abnormal receptor and antigenic expression
Metastasis

• indicates malignancy
• a discontinuous spread of the tumor
• Methods of metastasis include: (1)seeding
of body cavities, (2) lymphatic spread, and
(3) hematogenous spread.
metastatic ovarian carcinoma
MRI: metastatic adenocarcinoma
metastatic adenocarcinoma
Grading and staging

• Grading is based on the microscopic

features of the cells which compose a tumor
and is specific for the tumor type.
• Staging is based on clinical, radiological,
and surgical criteria, such as, tumor size,
involvement of regional lymph nodes, and
presence of metastases. Staging usually has
more prognostic value.
Morbidity and mortality

• metastases
• rupture into major vessels
• compression of vital organs
• organ failure
• infection
meningioma
basal cell carcinoma
melanoma
 Diagnostic procedures
• FNA (fine needle aspiration)
• Cytological smears
• Biopsy
• Frozen sections
• Biochemical assays
• Molecular diagnosis
• Flow cytometry
cytology smear: adenocarcinoma
Pap smear with dysplasia
frozen section
staining a frozen section
Ancillary studies

• Immunohistochemistry
• Cytogenetics
• Flow cytometry
• Electron microscopy
cytokeratin stain on a carcinoma
AFP stain on a yolk sac tumor
EM: neurosecretory granules
EM: microvilli, tight junction in
an adenocarcinoma
Biochemical assays

• Tumor markers: sometimes diagnostic or

prognostic
• Can be helpful in monitoring effectiveness
of therapy or in detecting
relapses/recurrences
Summary
• Neoplasia- an abnormal mass of tissue which
has lost its responsiveness to growth controls
• Benign neoplasms tend to be slow-growing,
well-differentiated tumors which lack the
ability to metastasize
• Benign neoplasms, in general, remain
localized and are amenable to surgery
Summary

• Malignant neoplasms tend to be fast-

growing lesions which invade normal
structures
• Malignant neoplasms vary in the degree of
differentiation and some show anaplasia
• Malignant neoplasms are capable of
metastasis
Summary

• The prognosis of a patient with any type of

neoplasm depends on a number of factors
including: the rate of growth of the tumor,
the size of the tumor, the tumor site, the cell
type and degree of differentiation, the
presence of metastasis, responsiveness to
therapy, and the general health of the
patient.